Entrance Examination | Abbey Pathways

10%

Section 1: Details of the Applicant
Please use the name as seen on your passport
Family Name*
Forename(s)*
Marital Status
Maiden Name (if applicable)
Date of Birth*
Present Age*
Gender*
- Male
- Female
Nationality*
Region of birth*
City of birth*
Country of birth:*
Passport No. (for overseas applicants):
Place of issue
Home Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Home Phone*
Mobile Phone*
Email
Address for correspondence, reports and fees payment (if different)
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Home Phone*
Mobile Phone*
Email
Who will be responsible for paying fees? Please state relationship to student:*
Address (if different from above)
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Section 2: Health
Does the Applicant take medication on a regular basis, or have any health issues?
- Yes
- No

Section 4: Course Details
Which degree course do you wish to apply for?*
- Medicine
- Dentistry
- Physiotherapy
- Nursing
- Pharmacy
- Veterinary Medicine
- Veterinary Food Safety
- Occupational Therapy
In most entrance examinations there are 3 papers in the following subjects: Biology, Chemistry and either Physics or Maths. For the third paper I will take*
** Please note for the Charles University Examination there is no choice of Physics or Maths. All applicants are required to sit a Physics paper.

Section 5: Details of Academic Record and Qualifications
To be completed by all Academic students only
Name of present School or College (or most recent if you have left school/college)
Address of present School or College (or most recent if you have left school/college)
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Year of Graduation
Name of University if applicable or Higher Education institute
Address of address of University if applicable or Higher Education institute
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Full Course Title
Year of Graduation
Examinations To Be Taken and Already Taken
Drop files here or
Please use a separate sheet if needed to list examination subjects, grades and dates and enclose copies of all certificates obtained to date. Please make it clear if results given are actual or predicted results (if predicted a letter should be attached to this application from the school/college with the predicted grades).

Section 6: Personal Statement
Upload Personal Statement*
Please attach a typed personal statement and copy of your CV to tell us about yourself and your interests. In particular explain why you wish to pursue your chosen course of study. Statements should be no longer than one A4 typed sheet.

Section 7: VISA
Do you require a visa to study in the Czech Republic or EU?*
- Yes
- No
Please note that some exams are for EU applicants only, non-EU students cannot sit these exams, however, please contact us and we may be able to book you in for an earlier exam to avoid visa complications. You must apply for the visa as soon as you receive your admission papers. Note EMUCAS cannot give detailed advice on visas or help with visa applications

Section 8: Declaration By Parent/Guardian or Sponsor. Please Complete A or B
I apply to enroll the student named in Section 1 of this form for the entrance examination. I undertake to pay all relevant fees and charges on or before the date on which they become due. I also understand that because of the start time limit there would be no refund of fees after the course/exam has been booked and all fees would be due for payment. I understand that the fees are not refundable unless stated otherwise. I understand that for some universities there is an additional application fee payable direct to the universities.
A ) Name of Person Signing*
First Last
Date*
Relationship to applicant
Name of Applicant*
First Last
Date*
B ) I am Sponsoring myself*
First Last
Date*

Authorisation for Credit Card Deduction
If, for security reasons, you prefer not to give this, please contact the college and speak to the Accounts Department to give details over the phone (+44 (0)1684 580852).
Name of cardholder (in full)
Name of student
Address, including postcode, of the card holder
Telephone number of the card holder
Relationship to the applicant
Type of card (if left blank, it will be treated as a credit card & charged accordingly)
- Credit
- Debit
Issue Number
Valid from
(For Switch/Solo/debit cards only)
Expiry date
Card number
Security Code (The last 3 digits of the number printed on the reverse of the card)
The amount to be deducted
Amount in words
The purpose for which the amount is to be deducted
The date on which the amount may be deducted
Signature

Section 1: Details of the Applicant